Using Simulation as a Capstone Experience in a
Nursing Residency Program
A Collaborative effort between Academia and Practice
Arlene Coughlin MSN, CNE, RN
J. Cedar Wang MSN, RN
Lori Podlinski MSN, MBA, RN
Barbara Blackwell EdD, RN-BC
There is no financial relationship or conflict of interest with any product or class of
products discussed in this educational activity.
Nurse Residency Program
• Form collaborative relationships
• Transition student into the professional role
• Ease reality shock
Nurse Residency
• Institute of Medicine (IOM)
• Increase skill attainment through the use of simulation
• Enhance patient safety through
reinforcing critical thinking skills
Clinical Simulation Reinforces Adult
Learning Theories
Experiential Learning
Reflective Learning
Transformational Learning
Clinical simulation finds support in educational literature
as a critical component of experiential learning (Dreifuerst, 2009).
Experiential Learning
Kolb (1984) states:
“Knowledge is derived from and tested out in experiences of the learner.
The knowledge and skill that is acquired in one experience becomes the
foundation by which the learner adapts to new experiences” (p.27).
REFLECTIVE LEARNING
Kolb (1984) proposes “learning occurs when an event is followed
by reflection and then critical discourse after which the learner
modifies their actions” (p.21).
Transformational Learning
Daloz (1999) states that “mentors are a key part on our
transformation reminding us that we can indeed survive
the terror of our journey and undergo transformation by
moving through not around our fears” (p.18).
Nurse Residency Simulation Objective
The nursing resident will integrate theory into
practice by using the metacognitive skills of critical
thinking and problem solving to determine prioritynursing actions in two clinical simulations.
Planning Process
Identifying
Objectives
8 weeks prior to simulation
• Faculty & Staff Development meet to identify learning objectives
Writing &
Programming
8 weeks prior to simulation
• Faculty review learning objectives and write 2 scenarios
• Medium fidelity mannequins are programmed to simulate scenarios
• Additional roles are identified and assigned
Testing of
2 weeks prior to simulation
Scenarios
• Faculty meet to test simulators
• “Live” run through
• Simulated medical records are written and compiled
• Final meeting with Staff Development to assign roles and to review scenarios
Collaborative Effort
deliver
autonomous self-directed
primary care to a group of
clients.
provides educational and
clinical support to RN
residents.
devises
simulation scenarios as RN
residents’ capstone experience.
Resident
Capstone
Event
Scenario Objectives
• Accurate assessment and identification of
client problems
• Safety measures including standard of
care
• Therapeutic communication
• Effective communication with
interdisciplinary team
• Prioritize and implement appropriate
interventions
• Evaluate client’s response to treatment
Resident Simulation Day
VitalSim Scenario 1
Resident Simulation Day
VitalSim Scenario 2
Equipment & Facility
• Laerdal® Vitals™ with
medium fidelity Nursing
Anne
• 2 simulated acute care
bedsides (oxygen, suction
equipment, cardiac
monitoring, IV pump,
telephone, patient chart,
simulated medications)
Resident Simulation Day Schedule
E-26: Pat Trick
E-28: Vincent Brody
9:00 – 9:30AM
RN 1
Observer
1
RN 2
Observer 2
9:30 –
10:00AM
RN 3
Observer
3
RN 4
Observer 4
10:00 –
10:30AM
RN 2
Observer
2
RN 1
Observer 1
10:30 –
11:00AM
RN 4
Observer
4
RN 3
(previously observer
1)
Observer 3
• 2 Scenarios
• 2 Roles for each
resident
– RN
– Observer (silent)
• Faculty and staff
development roles
– Mannequin controller
– Family member at the
bedside
– Physician
– Respiratory therapist
Facilitation Strategies
• Partial facilitator
prompting
• Reflective learning
• Formative
assessment
Debriefing/Guided Reflection
• How did you feel during the simulation
experience?
• What did you learn about interacting with
family members?
• What did you learn about collaborating with
interdisciplinary healthcare team members?
• What do you think you did correctly?
• What do you think you could have done
differently?
• What would you change about this
experience?
Additional Resources in Scenario
Development
• NLN, (2009). Chronic Obstructive
Pulmonary Disease – Oxygen Therapy
VitalSim Scenario. Laerdal Medical
Corporation.
• Debriefing/Guided Reflection Questions
Gasper, M.L. & Dillon, P.M. (2012). Clinical simulations
for nursing education: Learner volume. (p. 431).
Philadelphia, PA: F.A. Davis Company
Lessons Learned
Run simulation earlier in the Residency Program
Use simulation as a formative assessment that
factors into summative evaluation process
Lessons Learned
Include simulation
throughout the
student’s academic
career to assess
achievement of higher
level skills and better
prepare the graduate
nurse for practice
(Bensfield, Horsley, &
Leann, 2012).
Simulation
provides an
effective means to
evaluate
practitioner safety
and competency
(Beyea, van Reyn,
& Slattery, 2008)
Lessons Learned
Preparation is a
key ingredient to
enhancing
the fidelity of a
simulation
– Participant
– Scenario
– Environment
Lessons Learned
Effective debriefing is
essential to the learning
process (Dreifuerst, 2009).
Future Implications-Education
• Integration of simulation into all areas of
school curriculum to enhance attainment
of metacognitive, communication, and
psychomotor skills
• Introduce simulation as means of
formative assessment
• Use simulation as a summative
assessment of clinical skills
Future Implications-Practice
Use simulation as a means to validate skill attainment and competency in the
new graduate and experienced RN
New Graduate Orientation
Classic New Nurse Orientation
• Paid Orientation
– $15,460 or $32.21/hour
• Time investment
– 12 weeks orientation
 Time added as necessary
• Educational Benefit
– Variability in content
– Reality Shock
Return on Investment New Graduate
Orientation
Nurse Residency
• No orientation after
residency completed
• Lower Salary
– $9,600 or $20/hour
– No paid benefits
• Time investment
– 12 weeks
• Educational Benefit
– Close theory-practice gap
– Consistency in orientation
practice
References
Beyea, S. C., van Reyn, S., & Slattery, M. J. (2008). A nurse residency
program for competency development using human patient simulation.
Journal for Nurses in Staff Development, 23(2), 77-82.
Bensfield, L. A., Olech, M. J., & Horsley, T. L. (2012). Simulation for
high-stakes evaluation in nursing. Nurse Educator March/April, 37(2),
71-74.
Daloz, L.A. (1999). Mentor: Guiding the Journey of Adult Learners. San
Francisco, CA: Jossey-Bass.
Dreifuerst, K. (2009). The essentials of debriefing in simulation
learning: A concept analysis. Nursing Education Perspective 30, (2).
References
Gasper, M.L. & Dillon, P.M. (2012). Clinical simulations for nursing
education: Learner Volume. Philadelphia, PA: F.A. Davis Company.
Kolb, D. A. (1984). Experiential learning: Experience as the source of
learning and development. Englewood Cliffs, NJ: Prentice Hall.
NLN, (2009). Chronic Obstructive Pulmonary Disease – Oxygen
Therapy VitalSim Scenario. Laerdal Medical Corporation.
Tanner, C. (2009). The Case for Cases: A Pedagogy for Developing
Habits of Thought. Journal of Nursing Education, 48(6), 299.
Taylor, E.W. (1998). The theory and practice of transformational
learning: A critical review. Columbus, Ohio.